Contusions pulmonaires : aspects physiopathologiques et principes de prise en charge

Pulmonary contusions are common traumatic lung injury in 50% of severe thoracic traumas. Most of the patients are multi-injured. Except in cases of massive parenchymal destruction, the primitive lesion (contused area) is poorly symptomatic. Alveolocapillar ruptures characterize contused lung with haemorrhage in air spaces. In the hours following the trauma, an inflammatory reaction develops secondary to the pulmonary initial insult and to the general trauma. Its intensity depends on the occurrence of a diffuse acute lung injury, which impacts the prognosis. Maximal about the third day, the respiratory distress usually resolves in 8 days in absence of complications. Computed tomography is the reference diagnostic technique and may help to predict the need for mechanical ventilation. Although the management of the respiratory distress is supportive and non-specific, special attention should be provide to analgesia and physiotherapy in cases of parietal injuries.